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BMI declined significantly among children who underwent alloHSCT
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Survivors of childhood hematologic malignancies who underwent allogeneic hematopoietic stem-cell transplantation experienced significant declines in BMI, according to study results.
The decline in BMI was due primarily to a substantial decrease in lean mass, researchers said.
Allogeneic hematopoietic stem cell transplantation (alloHSCT) is an effective treatment for a variety of diseases, and it has contributed to increased survival rates among pediatric patients who are treated for both malignant and non-malignant diseases.
Prior studies have evaluated body mass and composition among survivors of childhood cancer, but little information is available about those factors specifically in the subset of patients who underwent alloHSCT, according to background information provided by researchers.
Hiroto Inaba, MD, PhD, an associate member of the faculty at St. Jude Children’s Research Hospital, and colleagues conducted a longitudinal study of survivors of pediatric hematologic malignancies to determine the effects of alloHSCT on BMI and composition.
The researchers analyzed 179 survivors by category (underweight, overweight, healthy-weight and obese) and z score from 1990 to 2007.
The study included patients aged at least 2 years who underwent alloHSCT for hematologic malignancy. They received follow-up from the time of transplantation through 2009.
During a median of 6.6 years of follow-up, BMI z scores decreased significantly (0.32 pre-HSCT vs. –0.6 at 10 years post-HSCT; P<.001).
Mean values of total body fat percentage remained at levels consistent with the general population, the researchers said.
Mean z scores for fat mass stayed within population norms, but those for lean mass remained below normal levels and diminished significantly over time (P=.018), Inaba and colleagues wrote.
Pre-HSCT BMI and z score were strong predictors of post-HSCT BMI (P<.001), as well as fat and lean mass z scores (P<.001), according to study results.
“Low BMI in general is an important predictor of morbidity and mortality and is associated with severe physiologic, psychologic and immunologic consequences,” Inaba and colleagues wrote.
Survivors with graft-versus-host-disease were more likely to have low BMI (P=.004) and low lean mass (P<.001) post-transplantation.
Older age at the time of HSCT and T-cell–depleted graft also were predictive of lower post-HSCT BMI, according to researchers.
Female patients had higher body fat and lower lean mass z scores (P=.013) than male patients. White patients (P=.026) had lower fat mass than black patients.
The findings suggest health care providers should recognize the potential for loss of BMI and lean mass in this patient population and ensure early, appropriate interventions, Inaba and colleagues concluded.
“We suggest that dietary education and exercise counseling are essential to improve the physical status and overall health of survivors with the risk factors identified in this study,” the researchers wrote.
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